Question 1

Will I need surgery, or can this fracture heal in a cast?

Accepted Answer

Almost all distal femur fractures (95%+) require surgery because the powerful thigh muscles pull bone fragments out of alignment, preventing healing in a cast - even if fracture initially appears non-displaced on X-ray, muscle forces will shift fragments within days, causing malunion (bone healing in poor position) and severe knee arthritis. Surgery realigns fragments precisely and holds them with metal plate/screws or intramedullary rod, allowing bone to heal in correct position while you do physiotherapy to prevent knee stiffness. Non-surgical treatment (casting) only considered in bedridden patients or those with severe medical conditions making anesthesia extremely dangerous - even then, non-surgical treatment has high failure rate (30-40% require surgery anyway when fracture shifts). Your surgeon will discuss surgery timing (usually within 24-48 hours of injury) and fixation method based on fracture pattern and your overall health.

Question 2

How long until I can walk and return to work after surgery?

Accepted Answer

Walking timeline depends on fracture stability and fixation method - with stable plate fixation, most patients start partial weight-bearing (50% body weight with crutches) immediately after surgery, progressing to full weight-bearing by 6-8 weeks once X-rays show early healing; with unstable fractures, you'll remain non-weight-bearing (no standing on leg) for 6-8 weeks, then gradually progress to full weight-bearing by 10-12 weeks. Walking independently without crutches typically achieved by 3-4 months. RETURN TO WORK: Sedentary office work possible at 6-12 weeks (once comfortable sitting and minimal pain); physical work involving standing, walking, or lifting requires 4-6 months depending on demands. DRIVING: Right leg fracture - no driving until off pain medications and can perform emergency brake (typically 8-12 weeks); left leg fracture with automatic car - may drive at 4-6 weeks if pain controlled. SPORTS: Recreational sports (cycling, swimming, golf) at 4-6 months; impact sports (running, tennis, skiing) at 9-12 months after bone fully healed and strength restored. Recovery is gradual - expect significant improvement every 4-6 weeks, but full recovery (return to all activities without limitation) may take 9-12 months.

Question 3

What are the risks and potential complications after surgery?

Accepted Answer

Most patients (75-85%) achieve good outcomes with bone healing and return to walking, but complications occur in 20-30% of cases. COMMON COMPLICATIONS: (1) KNEE STIFFNESS: Most common problem (15-25% of patients) - if you don't do aggressive physiotherapy, knee becomes stiff (inability to fully bend or straighten) causing difficulty walking, stairs, getting in/out of car - prevention requires daily physio exercises starting immediately after surgery (goal: 90+ degrees knee bend by 6-8 weeks). (2) INFECTION: 3-8% risk (higher in open fractures, diabetes, smoking) - presents as increasing pain, fever, wound drainage 1-3 weeks after surgery - treated with antibiotics, sometimes requiring surgery to clean infection; severe cases may need plate removal and prolonged IV antibiotics. (3) NON-UNION (bone fails to heal): 5-10% risk, higher in smokers, osteoporotic patients, diabetics - presents as persistent pain and inability to weight-bear 4-6 months after surgery - requires repeat surgery (bone grafting, stronger fixation, or bone stimulator). (4) MALUNION (bone heals crooked): 5-8% risk if fracture reduction not precise - causes knee arthritis, limping, leg length discrepancy - may require corrective surgery. (5) HARDWARE PROBLEMS: Screws may loosen or back out (5-10%), plate may break if walking before bone healed (2-3%), or hardware may cause irritation requiring removal after healing (10-15% elect hardware removal 18-24 months post-surgery). (6) NERVE/BLOOD VESSEL INJURY: Rare (less than 2%) - common peroneal nerve (controls foot/ankle) may be injured causing foot drop (difficulty lifting foot); vascular injury extremely rare but catastrophic. (7) BLOOD CLOTS (DVT/PE): 3-8% risk despite blood thinners - calf pain, swelling, shortness of breath require urgent evaluation. Australian context: Most complications manageable with good surgical care and physiotherapy - Medicare covers revision surgery if needed, but recovery from complications significantly prolongs timeline (non-union or infection may add 6-12 months to recovery).

Medical Disclaimer

Thigh Bone Fractures Near the Knee

📖What is Thigh Bone Fractures Near the Knee?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention